Notes from a Tadataka Yamada Talk

Last week I attended a seminar by Dr. Yamada who is now president of the Bill and Melinda Bates Foundation.

Here's a couple of interesting points from his talk:

- The pharmaceutical industry has developed and patented almost 15,000 drugs, only 30 of which are directed towards diseases that exclusively afflict the third world. You might be thinking "well what do you expect, in a capitalist economy, drugs go to those who can pay for them." However things are changing. Several of the big pharmas are developing drugs and vaccines directed against Malaria, TB and other tropical diseases. But according to Dr. Yamada more has to be done, especially in academic institutions. One problem is academia's current model of individual achievement rather than team effort. For example, it takes many researchers working in a highly structured team effort, to develop a vaccine. Academia is not involved in developing important, yet unprofitable treatments, because of its emphasis on individual accomplishment. Science after all is a pyramid scheme and this can only work in the context of individual achievement. For teamwork, academia would need career postdocs who were well paid ... don't expect this to happen any time soon.

- Besides funding research and health care initiatives, the Foundation works with both government agencies and the private sector to develop adequate public health policies in various third world countries. According to Dr. Yamada, in certain circumstances medical services can est be provided by the private sector (yes he said that) and in many cases the public sector has just wasted its money by underfunding health care institutions and providers. Dr. Yamada asked "who would go to a clinic if the government doesn't provide it with medicine?" For many poor countries, the government is just too poor to afford this. The solution may be HMOs and private clinics acording to the foundation. He then stated that in Kenya(?) a for-profit HMO/clinic provides health care to the local population for 25$ a year. According to the foundation, their facilities are much better than what the government offers.

- The Foundation can provide resources for certain health care initiatives in poor countries. These resources span from financing, to distribution logistics, to marketing. It's not only about developing and producing a service, such as a vaccine, but making sure that people have a way of obtaining the relevant information and can access these services. In other words thinking about every step from conceiving a treatment to how in ends up in the hands of those who need it.

- One question that is often asked of Dr. Yamada is why doesn't the Foundation have projects to increase the access to health care in the US? The Foundation can help with many problems to those that have limited resources, but it can't change political will. The Foundation has done great work in Mexico where vaccination rates have risen to 100%, where infant mortality has dramatically dropped in the past 5 years. Why? The government was willing to work with the foundation and had the political will to address these issues. But how about the US, especially in poor communities and in places like the inner city? Dr. Yamada flatly stated that in America there is ample human and financial resources, but a lack of political will. Translation, when you compare the US to other industrialized countries, it becomes obvious that the US can do better, but it is up to the politicians, because without political will there is nothing that can be done.